This study assessed the impact of running away on pregnancy in the subsequent year among U.S. adolescents. We also investigated interactions between running away and sexual assault, romance, and school disengagement. Pregnancy among females between 11 and 17 years (n = 6100) was examined utilizing the Longitudinal Study of Adolescent Health (Add Health) data from Waves 1 and 2. The odds of pregnancy in the next year were 1.67 times greater for runaways net of other factors. A history of sexual assault and romantic involvement increased the likelihood of pregnancy. The relationship between pregnancy and runaway behavior in the general population is understudied. Our findings suggest that runaway youth have a multiplicity of needs that require a complex array of medical, social, emotional, and academic resources to promote positive sexual health outcomes.